Toe Walking in Children

As parents, we are very concerned about how our children develop.  One thing that seems to push parents to seek a medical profession is how their child walks.  Is toe walking bad?  Does it mean that they will walk like that forever?  Is it a sign that something else may be wrong?  Let’s discuss.

Toe walking in and of its self is harmless and in most cases is simply how your child has decided to walk.  Many children simply have chosen to toe walk because it is comfortable for them at this stage.  If the child has been walking on their toes since their first step, there is additional assurance that nothing is wrong.  If the child is old enough to respond to verbal commands, ask them to stand on their heels and to walk with their heels touching the ground.  The far majority of children will be able to do this easily and painfree.  This is a sign that there is no underlying problem or surgical issue that needs to be addressed. 

Toe walking is only a sign of an underlying disorder when it is accompanied by other signs of slow development, or if the child was walking on their heels and then suddenly begins to walk on their toes.  If the child is missing other milestones of growth, cognitive development, or other benchmarks, a pediatric physician should be consulted.  If the child was walking normally and then begins to toe walk, or if they begin to toe walk only on one foot, this should also prompt evaluation.  Pinching of the spinal cord from a myriad of possible sources could be the reason and can be addressed and reversed.  It is possible, however,  that the abrupt toe walking is a sign of a muscle or nerve development problem that may not be so easy to reverse.  This represents a very small percentage of cases which your child most likely does not fit into.

In most cases, toe walking is not a sign of an underlying problem, and parents can be assured that their child will walk normally eventually.  We’ll discuss some other common worries parents have for their young children in future posts.

Treatment for Heel Pain in Kids

Last week we discussed Sever’s Disease, or calcaneal apophysitis, which is the major cause of heel pain in children.  Let’s now discuss how to help.

The most immediate relief can be gained by taking an anti-inflammatory medication like ibuprofen.  This will help take the edge off the pain and allow them to continue to participate in athletic events.  A higher dose of ibuprofen needs to be taken in order to have the pain relief.  Pediatric doses depend on the weight of the child and their ability to swallow pills.  This can have an very beneficial effect in a very short time.

Another easy thing that can be done it for the child to wear heel lifts.  A major component to the pain is the pull of the Achilles tendon on the growth plate.  Especially taut Achilles tendons must be relaxed in order to decrease their pull.  Heel lifts can take the tension off of the Achilles and allow the inflammatory process at the heel bone to calm down.

Achilles tendon stretching is the treatment which takes longer to have an effect, but will result in long term relief.  Stand facing a wall with feet facing forward and shoulder width apart.  Take two steps backward.  With one foot, take one step toward the wall, while keeping the other foot 2 steps from the wall.  Lean forward and place both hands against the wall while keeping both keep pointing forward.  This should cause the Achilles tendon in the foot furthest from the wall to be stretched.  This should not be painful, but should stretch the tight tendon.  Hold this position for 30 seconds then switch feet.  Do this at least 5 times a day, more if possible.  This will help to eventually eliminate this problem so that heel lifts and medication are no longer needed.

The combination of the previous treatments should help to resolve the heel pain in a matter of weeks, so that children can maintain their active lifestyles.

Heel Pain in Kids

Kids have an incredible ability to deal with pain.  I’ve seen young children take bad falls, run into walls, or accidently get hit by a flying object and not miss a beat.  They are stunned for a second, might shed a quick tear, but before you know it, they are back running around having fun.  Despite their ability to play through discomfort, there is a specific type of heel pain that seems to bring kids to the doctor that we should discuss.

In order for a child’s bones to grow, the body forms a “growth plate” which allows bones to grow in length.  These growth plates stay open into a child’s teenage years, allowing for maturation of their bodies.  These growth plates are very sensitive to injury and are easily irritated.  In a child’s heel, there is a growth plate which is commonly irritated as a child becomes more active in sports.  The Achilles tendon is attached to this growth plate, which leaves the growth plate susceptible to the strong pull of this strong tendon as the bone grows.   This is a very common condition in kids, which is called Calcaneal Apophysitis, or Sever’s Disease.

Symptoms that most children will experience are heel pain toward the end or after playing sports.  There may be some mild swelling, but no bruising and the child will not be able to recall a specific event that caused their heels to hurt.  Pain will slowly go away with rest, but will return if participation in sports is re-started.  Sever’s disease is very commonly seen at the beginning of a new sports season, when wearing tight cleats or new athletic shoes,  or when suddenly increasing activity after a relatively less active time period.  Most children will recognize that something is not right and complain of their feet hurting.

Thankfully, this condition is very common and is not associated with long term foot pain.  With some slight modification to shoe gear and other minor changes, most children will be pain free in 2-4 weeks and not miss any part of their athletic season.  We’ll discuss treatment options next post.

Surgical Treatment of Warts

If conservative treatment for warts is unable to effectively kill the virus, or the warts seem to recur frequently to the point that weekly visits to the podiatrist for the next couple months are needed, it is reasonable to pursue surgical removal.  Although the warts can come back, this is an effective method of treatment. This can be accomplished in different ways.

The simplest way to achieve wart removal is simply to cut it out.  If there are only a couple warts and if they are not too deep, this can be done with local anesthetic in the office.  A small amount of numbing medicine will be put around the wart to make the procedure as painless as possible.  The procedure is done with a scalpel and a curette, which allows the podiatrist to completely remove all virus infected tissue.  A small dressing and some ointment will then be applied and need to be changed for the next couple weeks while the wound heals.  The location will be tender for the upcoming weeks, so wearing a special shoe that off loads the area may be more comfortable.

If the wart is too deep or the involvement is too wide spread, it may be necessary to be taken to the operating room for removal there.  The procedure is the same as outlined above; however, the patient is sedated in addition to the local anesthetic to decrease the amount of pain.  This allows the doctor to be more aggressive to insure complete removal of warty tissue.  Cautery and/or lasers are now often used to burn the edges of the previous wart to kill any additional virus left behind.  This process of curettage, followed by cautery, then repeating the cycle can be very effective in killing the virus.

Although warts are certainly not life threatening, if they are found on the weight bearing surface of the feet, they can alter your activities and decrease your ability to experience painless exercise.  Talk to your podiatrist if you are struggling with recurrent planter’s warts.  Together, you will find a solution to the problem.

Warts Treatment Continued

Wart treatment continues to develop and newer treatment modalities continue to come out.  Let’s discuss some of the more popular treatments.

The reason why warts persist so long is that they hide from the immune system by living in the thick skin of the plantar skin.  A popular theory now being investigated is injecting something into the wart that will alert the immune system.  Candida albicans, a yeast known for causing oral thrush and yeast infections, has been injected into warts.  The immune system then begins to attack the yeast, and at the same time realizes the presence of the wart and begins to attack it.  This treatment has shown promising results in some, but doesn’t work for everyone.  Talk to your podiatrist if you are interested in attempting this mode of treatment.

Another treatment for warts is called bleomycin.  This may alarm some of you who know that this medication is a chemotherapy agent for those undergoing cancer treatments.  However, when using this medication for wart treatment, bleomycin is diluted down and is only injected into the most superficial part of the skin, similar to how TB tests are done.  Bleomycin stays locally inside the wart and does not get into your circulation.  After one application, the wart will turn black over a 2 week period.  The wart is then debrided using a scalpel.  Often, only one or two treatment is necessary.  If used correctly, this treatment is very effective in only a few office visits.

Another product being used for wart treatment is canthacur.  This is a product that comes from the saliva of an exotic beetle.  It is a very potent chemical that when applied to skin will cause blistering and lifting of the skin, which will cause the wart virus to die.  This is a newer treatment that is slowly gaining favor.  The most commonly seen problem with this treatment is that the chemical, when the foot begins to sweat, will dissolve and not stay over the affected area.  This will obviously decrease the effectiveness of the treatment.

If these conservative measures fail, there are some surgical options that can be pursued.  We’ll discuss these next post.

Warts Treatment

Warts have become so common that health professionals use a myriad of treatments, not to mention home remedies and folk remedies that are shared on personal blogs and websites alike.  We’ll go over some of the more common treatments used by professionals, and mention some of the more popular home recipes.

The best treatment for any condition is prevention.  The best way to prevent picking up the virus is to wear footwear in public areas where water is present.  Be especially careful around locker room showers at health clubs, or at public swimming pools.  If you have an open cut or a break in the skin, be especially cautious.  If you think your shower may be contaminated, a dilute bleach cleaning solution will be sufficient to remove the virus.

A common treatment used by podiatrists is salicylic acid.  This acid works by slowly eating away at the skin infected by wart.  The acid is in a cream form, is applied every week for 5-6 weeks, and is covered with a strong adhesive tape such as duct tape to ensure the acid stays in the correct spot.  After each treatment, the dead skin is shaved away with a scalpel to get to the deeper skin where the wart is hiding.  This is an effective, painless way to get rid of a plantar wart.  The downside is that it requires consistent office visits over a couple weeks.

Another common treatment for warts is cryotherapy, or freezing the warts.  By using a very direct freezing solution, you can induce a local frost bite on the wart, causing the skin and therefore the wart to die.  Similar to salicylic acid, this is a treatment that needs to be applied several times over a couple weeks.  A common mistake when using this treatment is that the cryotherapy is not applied long enough to penetrate the thick skin of the plantar skin.  In order for freezing to work, the therapy must be applied long enough for the treatment to be painful.  For this reason, podiatrists are using this therapy less and less.

We’ve only scratched the surface of wart treatment.  We’ll discuss some more next post.

How did I get this wart?

Summer time is slowly coming to an end, a time of year that many kids spend endless hours at the pool.  It is normal to get a few bumps and scratches along the way, especially on the toes and feet.  Breaks in the skin allow potential viruses to get into the skin and grow.  One of the most common viruses found in this environment is the virus that causes plantar warts.

Verrucae, commonly known as warts, are the result of an infection of a virus, which is part of a family of viruses called the human papilloma virus or HPV.   If that sounds familiar to you, it is because this family of viruses is responsible for cervical cancer and gential warts.  Thankfully, when concerning the manifestation of warts on the feet, they are benign and will disappear on their own without any treatment in a couple of years.

The virus is confined to the thick skin on the soles of the feet, which while it keeps the virus from spreading, it allows the virus to hide from the immune system.  This allows the virus to grow and seed on the plantar skin.

How can we tell a wart from a simple callus or IPK?  When shaved with a small blade, a wart will have small distinct pores that will bleed, a phenomenon termed “pin point bleeding.”  In addition, the skin lines on the soles of the feet will be interrupted by the growth of the wart.  Another way to correctly diagnose a wart will be to squeeze the wart between your fingers.  This will induce exquisite pain, more so than if direct pressure is applied to the surface of the wart.

As you probably know, this is a very common problem among children and young adults.  As such, there is no end to the many treatments that have been attempted, some more successful than others.  We’ll discuss the possible treatments in the upcoming posts.